Don't worry, you're not alone. Many beginning ultrasonographers have difficulty with the standard cadiac views. This isn't hard to imagine as 1) the heart is a moving object, and desired views come in and out of focus quickly, 2) the window is quite small for scanning (i.e. between the ribs, and under the xiphoid) and 3) patient habitus is commonly prohibitive, unless you employ certain techniques to maximize your chance of obtaining great real-time ultrasound.

Admittedly, I wasn't great at cardiac ultrasound until the first few weeks of my fellowship when I was able to dedicate significant time to reading cardiac chapters and spending unpressured time at the bedside (with a lot of skinny patients)!

Hang in there though, and don't get frustrated early. Hopefully the following instructions will help you arrive at the appropriate four cardiac images consistently. As always, grab me at any time and I'll come scan with you.

The four cardinal views:

1) Subcostal Four Chamber (easy)

2) Apical Four Chamber (more difficult)

3) Parasternal Long Axis (not too bad)

4) Parasternal Short Axis (cake if you've got #3)